Service Billing
code
Payer and
amount
Description
Full
screen
CPT
96160
Medicaid
$7-10
  • Administration of a patient-focused health risk assessment instrument, with scoring and documentation, per standardized instrument.*
Commercial
$12-21
G0442 Medicare
$6-13
  • Screening for alcohol misuse in adults once per year. No coinsurance or patient deductible.
Brief
intervention
G0443 Medicare
$16-18
  • Up to four, 15-minute, face-to-face brief interventions per year for individuals who screen positive for unhealthy alcohol use. No coinsurance; no deductible for patient.
Full
screen
+
brief
intervention
CPT
99408
Medicaid
$23-35
  • ≥15 minutes of aggregate clinic time spent administrating and interpreting a validated alcohol or drug screening tool, plus performing a face-to-face brief intervention.
Commercial
$40-70
G0396 Medicare
$33-37
CPT
99409
Medicaid
$46-67
  • Same as above, but ≥30 minutes
Commercial
$77-135
G0397 Medicare
$66-71

Notes:

CPT codes listed above should be appended to E/M service with modifier 25. Payment amounts are estimates only.

ICD-10 diagnosis codes are poorly suited for most SBIRT patient scenarios. Sometimes Z13.89 or Z13.9 is used.

*Screening tools approved by the Oregon Health Authority (Medicaid) for reimbursement are listed here. Note that the Brief screen (single alcohol and drug questions) is not reimbursable.

Independent billing:

Only the following licensed professionals are allowed to bill the above codes independently:

Oregon Medicaid:
  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Licensed Clinical Psychologists
  • Licensed Clinical Social Workers
  • Licensed Professional Counselors
  • Licensed Marriage and Family Therapists
Medicare:
  • Physicians (MD, DO only)
  • Physician Assistants
  • Nurse Practitioners
  • Licensed Clinical Psychologists
  • Licensed Clinical Social Workers
  • Certified Nurse Midwives
  • Clinical Nurse Specialists

Incident-to billing under Oregon Medicaid:

Under Oregon Medicaid, any clinic employee or contractor acting under the supervision of a licensed and credentialed provider may be able to receive reimbursement for screening and brief intervention services, under incident-to rules. Examples of these individuals include (not an exhaustive list):

  • Certified alcohol and drug counselors (CADCs), medical assistants, nurses, health educators, community health workers, wellness coaches, students or graduates entering medical professions.

Incident-to billing rules may not apply towards all SBIRT workflows or settings. It is best to check with a billing specialist beforehand for guidance. Medicaid rules are subject to change, and providers should follow Oregon’s Administrative Rules as it relates to Medicaid billing guidelines.

More billing information:

Oregon Medicaid: Technical Specifications and Guidance Documents
Medicare: Screening, Brief Intervention, and Referral to Treatment (SBIRT) Service